|
CA 27.29 DMCL
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
8519159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$36.90 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Aetna of IA Medicare |
$46.74
|
| Rate for Payer: Amerigroup Medicaid |
$47.30
|
| Rate for Payer: Amerigroup Medicare |
$37.27
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$36.90
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$46.84
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$36.90
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$47.53
|
| Rate for Payer: Partners Health Alliance Commercial |
$42.44
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
| Rate for Payer: United Healthcare Managed Medicare |
$48.38
|
| Rate for Payer: Wellmark IA HMO WHPI |
$41.83
|
| Rate for Payer: Wellmark IA PPO |
$46.08
|
|
|
CA 27.29 DMCL
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
8519159
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of IA Commercial |
$73.80
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$73.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$61.50
|
| Rate for Payer: Medical Associates Commercial |
$61.50
|
| Rate for Payer: Midlands Choice Commercial |
$57.40
|
| Rate for Payer: United Healthcare Commercial |
$73.80
|
|
|
CABLE PLUGS FOR 4.0 MM LOCKING SCREWS
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of IA Commercial |
$51.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.30
|
| Rate for Payer: Aetna of IA Medicare |
$32.49
|
| Rate for Payer: Amerigroup Medicaid |
$32.88
|
| Rate for Payer: Amerigroup Medicare |
$25.91
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$25.65
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$32.56
|
| Rate for Payer: Medical Associates Commercial |
$42.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$25.65
|
| Rate for Payer: Midlands Choice Commercial |
$39.90
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$33.04
|
| Rate for Payer: Partners Health Alliance Commercial |
$29.50
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: United Healthcare Managed Medicare |
$33.63
|
|
|
CABLE PLUGS FOR 4.0 MM LOCKING SCREWS
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
8046631
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna of IA Commercial |
$51.30
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$51.30
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$42.75
|
| Rate for Payer: Medical Associates Commercial |
$42.75
|
| Rate for Payer: Midlands Choice Commercial |
$39.90
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
|
|
CADEXOMER IODINE GEL 40G 11.4 OZ
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS A6261
|
| Hospital Charge Code |
8013712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna of IA Commercial |
$113.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$113.40
|
| Rate for Payer: Aetna of IA Medicare |
$71.82
|
| Rate for Payer: Amerigroup Medicaid |
$72.68
|
| Rate for Payer: Amerigroup Medicare |
$57.27
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$94.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$56.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$71.97
|
| Rate for Payer: Medical Associates Commercial |
$94.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$56.70
|
| Rate for Payer: Midlands Choice Commercial |
$88.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$73.03
|
| Rate for Payer: Partners Health Alliance Commercial |
$65.20
|
| Rate for Payer: United Healthcare Commercial |
$113.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$74.34
|
|
|
CADEXOMER IODINE GEL 40G 11.4 OZ
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS A6261
|
| Hospital Charge Code |
8013712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Aetna of IA Commercial |
$113.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$113.40
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$94.50
|
| Rate for Payer: Medical Associates Commercial |
$94.50
|
| Rate for Payer: Midlands Choice Commercial |
$88.20
|
| Rate for Payer: United Healthcare Commercial |
$113.40
|
|
|
caffeine 200 mg Tab [VDMC]
|
Facility
|
IP
|
$1.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10372627
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna of IA Commercial |
$1.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.44
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.20
|
| Rate for Payer: Medical Associates Commercial |
$1.20
|
| Rate for Payer: Midlands Choice Commercial |
$1.12
|
| Rate for Payer: United Healthcare Commercial |
$1.44
|
|
|
caffeine 200 mg Tab [VDMC]
|
Facility
|
OP
|
$1.60
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10372627
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.72 |
| Max. Negotiated Rate |
$1.44 |
| Rate for Payer: Aetna of IA Commercial |
$1.44
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.44
|
| Rate for Payer: Aetna of IA Medicare |
$0.91
|
| Rate for Payer: Amerigroup Medicaid |
$0.92
|
| Rate for Payer: Amerigroup Medicare |
$0.73
|
| Rate for Payer: Cash Price |
$1.28
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.20
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.72
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.92
|
| Rate for Payer: Medical Associates Commercial |
$1.20
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.72
|
| Rate for Payer: Midlands Choice Commercial |
$1.12
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$1.44
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.95
|
|
|
caffeine citrated soln 60mg/3ml SDV [VDMC]
|
Facility
|
OP
|
$34.60
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
10372698
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$221.80 |
| Rate for Payer: Aetna of IA Commercial |
$31.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.14
|
| Rate for Payer: Aetna of IA Medicare |
$19.72
|
| Rate for Payer: Amerigroup Medicaid |
$19.96
|
| Rate for Payer: Amerigroup Medicare |
$15.73
|
| Rate for Payer: Cash Price |
$27.68
|
| Rate for Payer: Cash Price |
$27.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.95
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.57
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.76
|
| Rate for Payer: Medical Associates Commercial |
$25.95
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.57
|
| Rate for Payer: Midlands Choice Commercial |
$24.22
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$20.05
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.91
|
| Rate for Payer: United Healthcare Commercial |
$31.14
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.41
|
| Rate for Payer: Wellmark IA HMO WHPI |
$201.36
|
| Rate for Payer: Wellmark IA PPO |
$221.80
|
|
|
caffeine citrated soln 60mg/3ml SDV [VDMC]
|
Facility
|
IP
|
$34.60
|
|
|
Service Code
|
HCPCS J0706
|
| Hospital Charge Code |
10372698
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.22 |
| Max. Negotiated Rate |
$31.14 |
| Rate for Payer: Aetna of IA Commercial |
$31.14
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$31.14
|
| Rate for Payer: Cash Price |
$27.68
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.95
|
| Rate for Payer: Medical Associates Commercial |
$25.95
|
| Rate for Payer: Midlands Choice Commercial |
$24.22
|
| Rate for Payer: United Healthcare Commercial |
$31.14
|
|
|
calamine-zinc oxide Top 8% susp [VDMC]
|
Facility
|
OP
|
$9.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11558119
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Aetna of IA Commercial |
$8.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.93
|
| Rate for Payer: Aetna of IA Medicare |
$5.65
|
| Rate for Payer: Amerigroup Medicaid |
$5.72
|
| Rate for Payer: Amerigroup Medicare |
$4.51
|
| Rate for Payer: Cash Price |
$7.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.44
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$4.46
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$5.67
|
| Rate for Payer: Medical Associates Commercial |
$7.44
|
| Rate for Payer: Medical Associates Managed Medicare |
$4.46
|
| Rate for Payer: Midlands Choice Commercial |
$6.94
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$5.75
|
| Rate for Payer: Partners Health Alliance Commercial |
$5.13
|
| Rate for Payer: United Healthcare Commercial |
$8.93
|
| Rate for Payer: United Healthcare Managed Medicare |
$5.85
|
|
|
calamine-zinc oxide Top 8% susp [VDMC]
|
Facility
|
IP
|
$9.92
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11558119
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Aetna of IA Commercial |
$8.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$8.93
|
| Rate for Payer: Cash Price |
$7.94
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$7.44
|
| Rate for Payer: Medical Associates Commercial |
$7.44
|
| Rate for Payer: Midlands Choice Commercial |
$6.94
|
| Rate for Payer: United Healthcare Commercial |
$8.93
|
|
|
calcitonin 200 intl units/inh 3.7ml nasal spray bottle [VDMC]
|
Facility
|
OP
|
$261.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
21526388
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$117.59 |
| Max. Negotiated Rate |
$235.19 |
| Rate for Payer: Aetna of IA Commercial |
$235.19
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$235.19
|
| Rate for Payer: Aetna of IA Medicare |
$148.95
|
| Rate for Payer: Amerigroup Medicaid |
$150.73
|
| Rate for Payer: Amerigroup Medicare |
$118.77
|
| Rate for Payer: Cash Price |
$209.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.99
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$117.59
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$149.27
|
| Rate for Payer: Medical Associates Commercial |
$195.99
|
| Rate for Payer: Medical Associates Managed Medicare |
$117.59
|
| Rate for Payer: Midlands Choice Commercial |
$182.92
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$151.46
|
| Rate for Payer: Partners Health Alliance Commercial |
$135.23
|
| Rate for Payer: United Healthcare Commercial |
$235.19
|
| Rate for Payer: United Healthcare Managed Medicare |
$154.18
|
|
|
calcitonin 200 intl units/inh 3.7ml nasal spray bottle [VDMC]
|
Facility
|
IP
|
$261.32
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
21526388
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$182.92 |
| Max. Negotiated Rate |
$235.19 |
| Rate for Payer: Aetna of IA Commercial |
$235.19
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$235.19
|
| Rate for Payer: Cash Price |
$209.06
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$195.99
|
| Rate for Payer: Medical Associates Commercial |
$195.99
|
| Rate for Payer: Midlands Choice Commercial |
$182.92
|
| Rate for Payer: United Healthcare Commercial |
$235.19
|
|
|
calcitonin 200 intl units/mL 2ml MDV Inj Sol [VDMC]
|
Facility
|
OP
|
$1,295.74
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
10431376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$583.08 |
| Max. Negotiated Rate |
$1,166.17 |
| Rate for Payer: Aetna of IA Commercial |
$1,166.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,166.17
|
| Rate for Payer: Aetna of IA Medicare |
$738.57
|
| Rate for Payer: Amerigroup Medicaid |
$747.38
|
| Rate for Payer: Amerigroup Medicare |
$588.91
|
| Rate for Payer: Cash Price |
$1,036.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$971.80
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$583.08
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$740.13
|
| Rate for Payer: Medical Associates Commercial |
$971.80
|
| Rate for Payer: Medical Associates Managed Medicare |
$583.08
|
| Rate for Payer: Midlands Choice Commercial |
$907.02
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$751.01
|
| Rate for Payer: Partners Health Alliance Commercial |
$670.55
|
| Rate for Payer: United Healthcare Commercial |
$1,166.17
|
| Rate for Payer: United Healthcare Managed Medicare |
$764.49
|
|
|
calcitonin 200 intl units/mL 2ml MDV Inj Sol [VDMC]
|
Facility
|
IP
|
$1,295.74
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
10431376
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$907.02 |
| Max. Negotiated Rate |
$1,166.17 |
| Rate for Payer: Aetna of IA Commercial |
$1,166.17
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1,166.17
|
| Rate for Payer: Cash Price |
$1,036.59
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$971.80
|
| Rate for Payer: Medical Associates Commercial |
$971.80
|
| Rate for Payer: Midlands Choice Commercial |
$907.02
|
| Rate for Payer: United Healthcare Commercial |
$1,166.17
|
|
|
calcitriol 0.25 mcg Oral Cap [VDMC]
|
Facility
|
OP
|
$2.07
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10372828
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna of IA Commercial |
$1.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.86
|
| Rate for Payer: Aetna of IA Medicare |
$1.18
|
| Rate for Payer: Amerigroup Medicaid |
$1.19
|
| Rate for Payer: Amerigroup Medicare |
$0.94
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.55
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.93
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.18
|
| Rate for Payer: Medical Associates Commercial |
$1.55
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.93
|
| Rate for Payer: Midlands Choice Commercial |
$1.45
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.20
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.07
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.22
|
|
|
calcitriol 0.25 mcg Oral Cap [VDMC]
|
Facility
|
IP
|
$2.07
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10372828
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna of IA Commercial |
$1.86
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.86
|
| Rate for Payer: Cash Price |
$1.65
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.55
|
| Rate for Payer: Medical Associates Commercial |
$1.55
|
| Rate for Payer: Midlands Choice Commercial |
$1.45
|
| Rate for Payer: United Healthcare Commercial |
$1.86
|
|
|
CALCIUM
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
1628887
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of IA Commercial |
$44.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.10
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.75
|
| Rate for Payer: Medical Associates Commercial |
$36.75
|
| Rate for Payer: Midlands Choice Commercial |
$34.30
|
| Rate for Payer: United Healthcare Commercial |
$44.10
|
|
|
CALCIUM
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
1628887
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Aetna of IA Commercial |
$44.10
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$44.10
|
| Rate for Payer: Aetna of IA Medicare |
$27.93
|
| Rate for Payer: Amerigroup Medicaid |
$28.26
|
| Rate for Payer: Amerigroup Medicare |
$22.27
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$36.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$22.05
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$27.99
|
| Rate for Payer: Medical Associates Commercial |
$36.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$22.05
|
| Rate for Payer: Midlands Choice Commercial |
$34.30
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$28.40
|
| Rate for Payer: Partners Health Alliance Commercial |
$25.36
|
| Rate for Payer: United Healthcare Commercial |
$44.10
|
| Rate for Payer: United Healthcare Managed Medicare |
$28.91
|
| Rate for Payer: Wellmark IA HMO WHPI |
$30.49
|
| Rate for Payer: Wellmark IA PPO |
$33.58
|
|
|
calcium acetate 667 mg Cap [VDMC]
|
Facility
|
IP
|
$2.09
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373031
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of IA Commercial |
$1.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.88
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.57
|
| Rate for Payer: Medical Associates Commercial |
$1.57
|
| Rate for Payer: Midlands Choice Commercial |
$1.46
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
|
|
calcium acetate 667 mg Cap [VDMC]
|
Facility
|
OP
|
$2.09
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373031
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.94 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna of IA Commercial |
$1.88
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.88
|
| Rate for Payer: Aetna of IA Medicare |
$1.19
|
| Rate for Payer: Amerigroup Medicaid |
$1.21
|
| Rate for Payer: Amerigroup Medicare |
$0.95
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$1.57
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.94
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$1.19
|
| Rate for Payer: Medical Associates Commercial |
$1.57
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.94
|
| Rate for Payer: Midlands Choice Commercial |
$1.46
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$1.21
|
| Rate for Payer: Partners Health Alliance Commercial |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$1.88
|
| Rate for Payer: United Healthcare Managed Medicare |
$1.23
|
|
|
calcium carbonate 500 mg(1250mg) Tab [VDMC]
|
Facility
|
IP
|
$1.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373100
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of IA Commercial |
$1.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.00
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Midlands Choice Commercial |
$0.77
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
|
|
calcium carbonate 500 mg(1250mg) Tab [VDMC]
|
Facility
|
OP
|
$1.11
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373100
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.50 |
| Max. Negotiated Rate |
$1.00 |
| Rate for Payer: Aetna of IA Commercial |
$1.00
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.00
|
| Rate for Payer: Aetna of IA Medicare |
$0.63
|
| Rate for Payer: Amerigroup Medicaid |
$0.64
|
| Rate for Payer: Amerigroup Medicare |
$0.50
|
| Rate for Payer: Cash Price |
$0.89
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.83
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.50
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.63
|
| Rate for Payer: Medical Associates Commercial |
$0.83
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.50
|
| Rate for Payer: Midlands Choice Commercial |
$0.77
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.64
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.57
|
| Rate for Payer: United Healthcare Commercial |
$1.00
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.65
|
|
|
calcium carbonate 500 mg Chew Tab [VDMC]
|
Facility
|
OP
|
$1.04
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10373169
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.47 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna of IA Commercial |
$0.93
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$0.93
|
| Rate for Payer: Aetna of IA Medicare |
$0.59
|
| Rate for Payer: Amerigroup Medicaid |
$0.60
|
| Rate for Payer: Amerigroup Medicare |
$0.47
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.78
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.47
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.59
|
| Rate for Payer: Medical Associates Commercial |
$0.78
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.47
|
| Rate for Payer: Midlands Choice Commercial |
$0.72
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.60
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.54
|
| Rate for Payer: United Healthcare Commercial |
$0.93
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.61
|
|
